Becchetti C, Dirchwolf M, Banz V, Dufour JF. Medical management of metabolic and cardiovascular complications after liver transplantation. World J Gastroenterol 2020; 26(18): 2138-2154 [PMID: 32476781 DOI: 10.3748/wjg.v26.i18.2138]
Corresponding Author of This Article
Chiara Becchetti, MD, Research Associate, Hepatology, Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, MEM F807 Murtenstrasse, 35, Bern CH-3008, Switzerland. chiara.becchetti@insel.ch
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Chiara Becchetti, Melisa Dirchwolf, Jean-François Dufour, Hepatology, Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Bern CH-3008, Switzerland
Chiara Becchetti, Melisa Dirchwolf, Jean-François Dufour, Department of Biomedical Research, University of Bern, Bern CH-3008, Switzerland
Melisa Dirchwolf, Hepatology, Hepatobiliary Surgery and Liver Transplant Unit, Hospital Privado de Rosario, Rosario S2000GAP, Santa Fe, Argentina
Vanessa Banz, Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Bern CH-3008, Switzerland
Vanessa Banz, Department of Clinical Research, University of Bern, Bern CH-3008, Switzerland
Author contributions: Becchetti C and Dirchwolf M contributed to this paper with conception, literature review and writing the manuscript; Banz V and Dufour JF participated in drafting, critical revision and editing; all the authors approved the final version of the manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Chiara Becchetti, MD, Research Associate, Hepatology, Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, MEM F807 Murtenstrasse, 35, Bern CH-3008, Switzerland. chiara.becchetti@insel.ch
Received: January 29, 2020 Peer-review started: January 29, 2020 First decision: March 18, 2020 Revised: March 26, 2020 Accepted: April 29, 2020 Article in press: April 29, 2020 Published online: May 14, 2020 Processing time: 105 Days and 14.9 Hours
Abstract
Liver transplantation represents the only curative option for patients with end-stage liver disease, fulminant hepatitis and advanced hepatocellular carcinoma. Even though major advances in transplantation in the last decades have achieved excellent survival rates in the early post-transplantation period, long-term survival is hampered by the lack of improvement in survival in the late post transplantation period (over 5 years after transplantation). The main etiologies for late mortality are malignancies and cardiovascular complications. The latter are increasingly prevalent in liver transplant recipients due to the development or worsening of metabolic syndrome and all its components (arterial hypertension, dyslipidemia, obesity, renal injury, etc.). These comorbidities result from a combination of pre-liver transplant features, immunosuppressive agent side-effects, changes in metabolism and hemodynamics after liver transplantation and the adoption of a sedentary lifestyle. In this review we describe the most prevalent metabolic and cardiovascular complications present after liver transplantation, as well as proposing management strategies.
Core tip: Recently there has been an increasing interest in extra hepatic-related complications after liver transplantation because they widely affect late morbidity and mortality. Metabolic and cardiovascular diseases and de novo neoplasia are considered to be among the main complications affecting long- and mid-term prognosis after liver transplantation. In this review, we will assess the prevalence of metabolic and cardiovascular complications after liver transplantation, their impact on post-transplant morbidity and mortality, and the optimal medical management currently available.
